Provider Demographics
NPI:1912437880
Name:SMITH, SHAUNA (LSW)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N MARKET ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62863-1945
Mailing Address - Country:US
Mailing Address - Phone:618-263-4970
Mailing Address - Fax:618-263-4837
Practice Address - Street 1:1001 N MARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863-1945
Practice Address - Country:US
Practice Address - Phone:618-263-4970
Practice Address - Fax:618-263-4837
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490218551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical